Nutritional assessment of low-income elderly African-American population.

The purpose of this study was to perform a nutritional assessment of low-income, elderly African-American subjects, to develop appropriate nutritional intervention program suitable for their needs and taste to ensure maximum compliance. Twenty-three subjects (18 women and 5 men) aged 60 to 82 years participated in the study. A majority of the subjects had an income of $5,000 to $10,000/year and an education level below junior high school. Eighteen subjects had hypertension and eight of those also had diabetes mellitus. Weights ranged from 131 to 265 pounds, and blood cholesterol level varied from 200 to 288 mg/dL. Their diets were high in sodium and fat and low in fresh fruits and vegetables. Based on this preliminary information, we have developed an instrument to assess the nutritional knowledge of this low-income elderly African-American population and a nutrition education program. After 6 months, nutritional assessment will be performed again. This information will aid us in developing nutrition education modules for the low-income elderly African-American population in the United States.

Management of obesity in low-income African Americans.

The Bariatrics Clinic at Howard University Hospital was initiated to help low-income African-American adults with low literacy skills in obesity control. Fourteen African-American women and two men participated in the study. Essential components of the treatment included nutrition education, exercise, and behavior modification related to food intake. The nutrition education component involved teaching nutritional needs, taking into account low literacy skills, low economic status, and individual food preferences. A realistic diet plan was based on individual needs, economic status, availability of food, likes and dislikes, lifestyle, and family dynamics. On average, patients lost 2 lb a week on this program. On average, a 14-lb weight loss occurred in seven weeks. There has been a 10% dropout from this program as opposed to drop out rates of 40% to 50% with other treatments. The main reasons for the success of this program is that it is individualized and is sensitive to food preferences.

High-fiber diet in the treatment of obesity and hypercholesterolemia.

Nine obese patients weighing 20% or more above the desired body weight with ages ranging from 38 to 73 years participated in a study in which they were given Meal Exchange for 1 to 8 months. Meal Exchange is a high-fiber (14.68 gm/2 tbsp) food product composed of nuts, nonfat milk, whole grains, and lactase. Total weight loss and cholesterol levels were recorded. There was significant weight loss and drop in blood cholesterol levels.

Adherence of Helicobacter pylori to cultured human gastric epithelial cells.

Experiments were performed to demonstrate that adherence of Helicobacter pylori to gastric epithelial cells causes alterations in the cell cytoskeleton. H. pylori intimately attached to cultured human gastric epithelial cells on small cellular projections, while there was no intimate association of H. pylori with cultured human esophageal epithelial cells. Fluorescein-conjugated phalloidin staining of gastric epithelial cells showed that H. pylori adherence stimulated actin polymerization; this stimulation was not observed with esophageal cells. Also, this organism's selectivity for gastric mucosa was supported by rare binding of bacteria to esophageal epithelial cells and gastric fibroblasts.

Sarcoidosis: a unique presentation of dysphagia, myopathy, and photophobia.

We report the case of a patient who presented with symptoms of dysphagia, muscle weakness, and photophobia. The diagnosis of sarcoidosis was made by the histologic evidence of widespread noncaseating epithelioid cell granulomas in more than one organ (anterior mediastinal node and right quadriceps muscle). The disease was proven to be active by elevated angiotensin-converting enzyme (ACE) level and gallium-67 imaging. Esophageal dysfunction was demonstrated by barium swallow and manometric study. A review of the literature on sarcoidosis involving the esophagus and the muscular system is presented. Dysphagia and acute symptomatic myopathy are rare presentations of sarcoidosis. The combination of symptoms is unique, and clearly demonstrates the protean multisystemic nature of sarcoidosis. Patients presenting with dysphagia and myopathy should be investigated for sarcoid granulomas in these organs for appropriate treatment.

Intraluminal radiation for esophageal cancer: a Howard University technique.

The objective of radiotherapeutic management in esophageal cancer is to accomplish maximum tumor sterilization with minimal normal tissue damage. This sincere effort is most often countered by the differential in tumor dose response vs normal tissue tolerance. Intraluminal isotope radiation, with its inherent advantage of rapid dose falloff, spares the lungs, the spinal cord, and other vital structures, yet yields adequately high doses to esophageal tumor. Though in existence since the turn of the century, the method of intracavitary radium bougie application dropped out of favor due to technical difficulties imposed by the size of the radium source and radiation exposure to the personnel involved. The authors describe a simple "iridium 192 afterloading intraluminal technique" that eliminates technical problems and reduces radiation exposure considerably.